No-anesthesia clear corneal phacoemulsification versus topical and topical plus intracameral anesthesia. Randomized clinical trial.

• Abstract: Purpose: To compare the intraoperative pain scores during clear corneal phacoemulsification under no anesthesia, topical anesthesia, and topical plus intracameral anesthesia.Setting: Dr. Agarwal's Eye Hospital and Eye Research Center, Chennai, India.Methods: Seventy-five patients were randomized to have phacoemulsification under no anesthesia, topical anesthesia, or topical plus intracameral anesthesia. Uncooperative or illiterate patients and those with hard cataract, a shallow anterior chamber, or small pupils were excluded. A protocol was established for supplemental anesthesia in case of breakthrough pain during the surgery. Each patient was asked to grade the overall severity of intraoperative pain immediately after surgery on a 10-point visual analog scale. Also evaluated were the general discomfort during surgery, discomfort from the microscope lights, surgeon stress during surgery, and total surgical time. Comparison among the 3 groups was performed using an analysis of variance.Results: No supplemental anesthesia was required in any group. No significant difference was noted in the mean scores of the subjective sensation of pain with or without topical anesthesia (P =.610). The mean scores of patient discomfort from the microscope lights and surgical time were also statistically insignificant. Patient discomfort and surgeon stress during surgery were significantly greater in the no-anesthesia group than in the topical and topical plus intracameral groups (P =.0235 and P = 0.0206, respectively).Conclusion: No-anesthesia clear corneal phacoemulsification was performed by a highly experienced, skilled surgeon without causing an unacceptable level of pain. However, this technique is not suitable for every cataract surgeon or patient.
• Authors: S K Pandey, L Werner, D J Apple, A Agarwal, A Agarwal, S Agarwal (Affiliation: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina 29425-5536, USA. pandeys at musc.edu)
• Journal: Journal of cataract and refractive surgery (J Cataract Refract Surg) Vol. 27 Issue 10 Pg. 1643-50 (Oct 2001) ISSN: 0886-3350 [Print] United States
• PMID: 11687365 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Anesthetics, Local
• Silicone Elastomers
• Lidocaine

Topics

• Adult
• Aged
• Anesthesia, Local (methods)
• Anesthetics, Local (administration & dosage)
• Anterior Chamber (drug effects)
• Cornea (surgery)
• Double-Blind Method
• Female
• Humans
• Lens Implantation, Intraocular
• Lenses, Intraocular
• Lidocaine (administration & dosage)
• Male
• Middle Aged
• Pain Measurement
• Patient Satisfaction
• Phacoemulsification (methods)
• Prospective Studies
• Questionnaires
• Silicone Elastomers